Dementia, Mild, Dementia, Moderate, Pain
Conditions
Brief summary
The purpose of the study is to develop a caregiver-assisted pain coping skills training program for older adults who have pain and mild to moderate dementia and are living at home with a family caregiver. The investigators are planning to recruit 30 patient-caregiver dyads (60 individuals).
Detailed description
Involving caregivers in a pain coping skills protocol is likely to optimize treatment outcomes in several ways. First, people with dementia (PWD) are likely to have difficulty learning and remembering pain coping skills; training the caregiver to coach the patient in the use of the skills is likely to improve the patients' acquisition and ongoing use of learned skills. Second, caregiver involvement in pain coping skills training may increase their understanding of how to gauge how much pain the PWD is experiencing and the impact of pain management strategies. This understanding is increasingly important as the patient's disease progresses, and s/he is less able to report pain verbally. Third, caregiver-assisted pain management training may enhance caregivers' self-confidence for managing the patient's pain. Finally, by participating in the pain coping skills training protocol, caregivers may learn coping skills (such as relaxation) that can help them manage the stress associated with caring for a PWD and pain which can be significant.
Interventions
BEHAVIORALCaregiver-Assisted Pain Coping Skills Training (CG-PCST)
Patient-caregiver dyads will receive five, forty-to-sixty-minute sessions over a six-to-eight-week period with a therapist to learn pain coping skills. These include training caregivers in strategies for assessing patient pain, including nonverbal pain behaviors (e.g., grimacing, bodily tension, labored breathing), which will become increasingly important as the patient's ability to express pain verbally decreases. The therapist will also train the caregiver to coach the patient in the use of the skills during activities that are challenging because of pain. We will focus on increasing positive patient-caregiver interactions and patient engagement in valued activities. Throughout the training, the therapist will help the patient and caregiver learn strategies for fostering regular home practice and application of the skills, identify challenges in using the skills, and find strategies for coping with challenges.
Sponsors
Duke University
National Institute on Aging (NIA)
National Institutes of Health (NIH)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Patients: * Mild or moderate dementia * Pain on most days for at least 3 months that interferes with function * Living at home (non-institutional) * Age ≥ 50 * English Speaking Caregivers: * Provides on average at least 4 hours/day of care/assistance to the patient * Age ≥ 18 * English Speaking
Exclusion criteria
Patient and caregivers * Lacking capacity for interview or unable to provide informed consent/assent. * Visual or hearing impairments or severe behavioral problems that preclude participation. * Too sick to participate.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Client Satisfaction Questionnaire | Post-intervention (approximately 8 weeks) | Caregiver completes. Score range: 1-4; higher score indicates better outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of life in Alzheimer's Disease Caregiver version and Patient version | Baseline and post-intervention (approximately 8 weeks) | Patient and Caregiver will complete Patient QOL. Score range: 13-52; higher score indicates better outcome |
| Brief Pain Inventory-Interference Items | Baseline and post-intervention (approximately 8 weeks) | Patient and Caregiver will complete Patient pain interference. Score range: 0-10; higher score indicates worse outcome |
| Caregiver Self-Efficacy in Pain Management | Baseline and post-intervention (approximately 8 weeks) | Caregiver will complete caregiver self-efficacy. Score range: 0-10; higher score indicates better outcome |
| Numeric pain scale & verbal descriptor | Baseline and post-intervention (approximately 8 weeks) | Patient will complete patient pain intensity. Score range: 0-19; higher score indicates worse outcome |
| Checklist of nonverbal pain indicators | Baseline and post-intervention (approximately 8 weeks) | Caregiver will complete patient pain intensity. Score range: 0-10; higher score indicates worse outcome |
| Zarit burden interview | Baseline and post-intervention (approximately 8 weeks) | Caregivers will complete caregiver burden. Score range: 0-88; higher score indicates worse outcome |
| Caregiver appraisal-satisfaction scale | Baseline and post-intervention (approximately 8 weeks) | Caregiver will complete caregiver satisfaction. Score range: 0-10; higher score indicates worse outcome |
| Neuropsychiatric inventory | Baseline and post-intervention (approximately 8 weeks) | Caregiver will complete patient neuropsychiatry behaviors. Score range: 0-144; higher score indicates worse outcome |
Countries
United States
Contacts
CONTACTLaura Porter, Ph.D
CONTACTKatherine Ramos, Ph.D
PRINCIPAL_INVESTIGATORLaura Porter, Ph.D
Duke University
Outcome results
None listed